PROJECT SUMMARY The novel coronavirus pandemic (COVID-19) has largely spared children, with relatively few requiring medical care. A small case series failed to reveal effects on birth outcomes in mothers with COVID-19 pneumonia, yet the absence of effects may in part relate to these mothers having been infected in third trimester, as the timing of infection is well known to influence adverse effects in pregnancy. A major barrier to population-based studies of SARS-CoV-2 infection has been the lack of a noninvasive method to detect viral RNA. Nasopharyngeal swabs are invasive, require personal protective equipment and swabs which have been in limited supply, and may be less sensitive than salivary samples for SARS-CoV-2 detection. Studies of adaptive immunity following infection in children have also been limited by the need for venipuncture to collect sufficient serum for validated testing of antibody. Our research team has developed novel methods for measuring SARS-CoV-2 infection in saliva, as well as IgG and IgM antibody responses to the spike protein and the receptor binding domain of SARS-CoV-2 in dried blood spots (DBS). Substantial psychosocial stress is likely to have occurred in pregnant women during the pandemic, whether due to fear of infection, job loss, economic stress, psychological or physical trauma, or other factors. Psychological stress during pregnancy is known to increase prematurity, yet stress and viral effects have not been examined together as yet. We had previously received PO permission to reallocate Year 4 funds in the NYU Children’s Health and Environment Study (CHES, UH3OD23305) and the Columbia Center for Children’s Environmental Health (CCCEH, UH3OD023290) to add remote and repeated saliva, dried blood spot, and hair collection in cohorts prospectively enrolling mothers into ECHO, using kits assembled by Fisher BioSciences for the ECHO program. We propose to expand this effort over the next year to newly enrolled mothers in NYU CHES (N=200 mothers), CCCEH (N=20 mothers) as well as the Michigan Archive for Research in Children’s Health (MARCH, UH3OD23285, N=20 mothers). We also wish to continue data collection in already enrolled NYU CHES (N=340 pregnant women as of March 1, 2020) and CCCEH (N=40 pregnant women as of March 1, 2020) mothers. The data will be supplemented by chart abstraction for all SARS-CoV-2 testing.

PROJECT NARRATIVE The novel coronavirus pandemic (COVID-19) has largely spared children, but perinatal exposure remains poorly understood. We propose to measure salivary RNA and antibody to SARS-CoV-2 in newly enrolled mothers in three cohorts participating in the NIH Environmental Influences on Child Health Outcomes, as well as biological measures of stress to evaluate effects on gestational length and birth weight.